=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427612027
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATI KERR CARLEY APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2019
-----------------------------------------------------
Last Update Date | 09/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2022 CHILHOWEE MEDICAL PARK
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37804-5285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-268-4360
-----------------------------------------------------
Fax | 865-329-6507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 BONNIE VISTA DR
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37804-3665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 25745
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------